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Nasal Carriage of Staphylococcus aureus Among Patients Receiving Allergen-Injection Immunotherapy: Associated Factors and Quantitative Nasal Cultures

Published online by Cambridge University Press:  02 January 2015

Stefano Bassetti
Affiliation:
Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North-Carolina
Donnie P. Dunagan
Affiliation:
Section on Pulmonary/Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North-Carolina
Ralph B. D'Agostino Jr
Affiliation:
Section on Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North-Carolina
Robert J. Sherertz*
Affiliation:
Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North-Carolina
*
Section on Infectious Diseases, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1042

Abstract

Objective:

To compare the prevalence of nasal Staphylococcus aureus carriage among outpatients receiving allergen-injection immunotherapy with the prevalence among healthy controls and to determine predictors of nasal S aureus carriage.

Design:

Survey.

Setting:

Allergy clinic of a university hospital.

Participants:

A volunteer sample consisting of 45 outpatients undergoing desensitization therapy and 84 first- and second-year medical students.

Results:

The nasal S aureus carriage rate was significantly higher among patients (46.7%) than among students (26.2%; P=.019). In a multivariate model adjusted for age and gender, the presence of atopic dermatitis or eczema was the only independent predictor of nasal S aureus carriage (odds ratio [OR], 4.4; 95% confidence interval [CI95], 1.2-16.0; P=.02). The only other participant characteristic associated with nasal S aureus carriage was immunotherapy with allergen injections (OR, 1.98; CI95, 0.7-6.0), but this association did not reach statistical significance (P=.23). The probability of nasal S aureus carriage was 88.9% for patients receiving allergen injections and having atopic dermatitis or eczema, and 36.1% for patients receiving allergen injections without atopic dermatitis or eczema.

Conclusions:

Patients undergoing desensitization have a higher nasal carriage rate of S aureus. However, factors other than the regular use of needles, and in particular abnormalities related to the atopic constitution of these patients, may predispose this population for S aureus carriage.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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References

1. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System report, data summary from October 1986-April 1996, issued May 1996. A report from the NNIS System. Am J Infect Control 1996;24:380388.Google Scholar
2. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990-May 1999, issued June 1999. A report from the NNIS System. Am J Infect Control 1999;27:520532.Google Scholar
3. Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:15981601.CrossRefGoogle ScholarPubMed
4. Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725730.Google Scholar
5. Herold, BC, Immergluck, LC, Maranan, MC, Lauderdale, DS, Gaskin, RE, Boyle-Vavra, S, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593598.Google Scholar
6. Centers for Disease Control and Prevention. Staphylococcus aureus with reduced susceptibility to vancomycin—Illinois, 1999. MMWR 2000;48:11651167.Google Scholar
7. Kluytmans, J, van Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505520.CrossRefGoogle ScholarPubMed
8. Perl, TM, Golub, JE. New approaches to reduce Staphylococcus aureus nosocomial infection rates: treating S. aureus nasal carriage. Ann Pharmacother 1998;32(suppl):S7S16.CrossRefGoogle ScholarPubMed
9. Winkler, J, Block, C, Leibovici, L, Faktor, J, Pitlik, SD. Nasal carriage of Staphylococcus aureus: correlation with hormonal status in women. J Infect Dis 1990;162:14001402.CrossRefGoogle ScholarPubMed
10. Gittelman, PD, Jacobs, JB, Lebowitz, AS, Tierno, PM Jr. Staphylococcus aureus nasal carriage in patients with rhinosinusitis. Laryngoscope 1991;101:733737.CrossRefGoogle ScholarPubMed
11. Aly, R, Maibach, HI, Shinefield, HR. Microbial flora of atopic dermatitis. Arch Dermatol 1977;113:780782.CrossRefGoogle ScholarPubMed
12. Kirmani, N, Tuazon, CU, Ailing, D. Carriage rate of Staphylococcus aureus among patients receiving allergy injections. Ann Allergy 1980;45:235237.Google ScholarPubMed
13. Klein, PA, Greene, WH, Fuhrer, J, Clark, RAF. Prevalence of methicillin-resistant Staphylococcus aureus in outpatients with psoriasis, atopic dermatitis, or HIV infection. Arch Dermatol 1997;133:14631465.CrossRefGoogle ScholarPubMed
14. Namura, S, Nishijima, S, Higashida, T, Asada, Y. Staphylococcus aureus isolated from nostrils anteriors and subungual spaces of the hand: comparative study of medical staff, patients and normal controls. J Dermatol 1995;22:175180.CrossRefGoogle ScholarPubMed
15. Bibel, DJ, Aly, R, Shinefield, HR, Maibach, HI, Strauss, WG. Importance of the keratinized epithelial cell in bacterial adherence. J Invest Dermatol 1982;79:250253.CrossRefGoogle ScholarPubMed
16. Holm, AF, Fokkens, WJ, Godthelp, T, Mulder, PG, Vroom, TM, Rijntjes, E. Effect of 3 months' nasal steroid therapy on nasal T cells and Langerhans cells in patients suffering from allergic rhinitis. Allergy 1995;50:204209.CrossRefGoogle Scholar
17. Yuta, A, Ali, M, Sabol, M, Gaumond, E, Baraniuk, JN. Mucoglycoprotein hypersecretion in allergic rhinitis and cystic fibrosis. Am J Physiol 1997;273(6 pt 1):L1203L1207.Google Scholar
18. Shuter, J, Hatcher, VB, Lowy, FD. Staphylococcus aureus binding to human nasal mucin. Infect Immun 1996;64:310318.Google Scholar
19. Shiomori, T, Yoshida, S, Miyamoto, H, Makishima, K. Relationship of nasal carriage of Staphylococcus aureus to pathogenesis of perennial allergic rhinitis. J Allergy Clin Immunol 2000;105:449454.CrossRefGoogle ScholarPubMed